UIN No: 512A212V01

Features & Conditions: Underwriting Rules:

LIC’s NEW CRITICAL ILLNESS BENEFIT RIDER Minimum age at entry : 18 years lbd Actual Sum Assured (ASA) for CIR-SUC:
(Cir: PD/90 Dtd 19/12/2016, NB&R/156 Dtd 20/12/2016, Launch Date: 19/12/2016) Maximum age at entry : 65 years lbd Basic S.A under New CIR Policies only is to
DETAILS: Max. cover ceasing age : 75 years nbd be taken and not to be clubbed with ASA
Allowed under following Plans at the time of Inception only: Term of Rider: under Basic Plan.
Plan 814 - New Endowment Plan Plan 830 - Limited Payment Endowment  Regular Prem. Policies: 5 to 35 years.
Non -Medical Schemes:
Plan 815 - New Jeevan Anand Plan 836 - Jeevan Labh  Limited PPT Policies : 10 to 35 years. Allowed under NMS, NMG(Professional)
Plan 820 - New Money Back Plan - 20 yrs Plan 838 - Jeevan Pragati  Policy Term and PPT should match B1( a) & (b), & Major Students:
Plan 821 - New Money Back Plan - 25 yrs with Basic Plan. Maximum CIR-SUC
Minimum S.A. : `1,00,000 & in
DEATH BENEFIT: No Death Benefit is payable. Age nbd NMS & NMG
multiples as per Basic Plan.
MATURITY BENEFIT: No Maturity Benefit is payable. Professional- B1(a) & (b)
Maximum S.A. : Equal to or less
18 to 35 15 Lakhs
CRITICAL ILLNESS BENEFIT: On first diagnosis of any one of the 15 Cri tical Illnesses then S.A under Basic Plan. Maximum
36 to 45 10 Lakhs
given below, Critical Illness Sum Assured is paid only once during the policy term: `25,00,000 under all Policies. (CIR taken
46 to 50 2 Lakhs
under Old Plans will not be counted.)
1. Cancer of Specified Severity 9 . Aortic Surgery Major Students upto age 25 yrs: 10 Lakhs.
Review of Premiums: Premium rates
2. Open Chest CABG 1 0 . Alzheimer's Disease/ Dementia Medical Examination & Special Reports:
can be revised every 5 years.
3. Myocardial Infarction 1 1 . Blindness FMR & Special Reports are required as per
Waiting Period: 90 days for first
4. Kidney Failure Requiring Regular Dialysis 1 2 . Third Degree Burns CIR-SUC, ECG & FBS are must in case of:
diagnosis of Critical illness from DOC of
5. Major Organ /Bone Marrow Transplant (As 1 3 . Open Heart Replacement or i. Age 18-35 Yrs & CIR-TRSA above 5 lakhs.
risk cover/revival. No waiting period
Recipient) Repair of Heart Valves ii. Age 36 Years LBD & above.
under accident cases.
6. Stroke Resulting in permanent symptoms 1 4 . Benign Brain Tumor
Survival Period: 30 days from date of Sub-Standard Major lives:
7. Permanent Paralysis of Limbs
1 5 . Primary (Idiopathic) Pulmonary diagnosis. If death occurs within Survival Up to EMR Class Two only, Physically
8. Multiple Sclerosis with persisting
Hypertension Period CIR benefit is not payable. Handicapped Lives are not allowed.
symptoms
CIR benefit payable will subject to Definition of Critical illnesses, Conditions, Restrictions, Mode of Payment: As per Basic Plan. Female Lives:
Waiting Period, Survival Period, Exclusions and Submission of Claim Requirements within Mode Rebate : As per Basic Plan Allowed to Category A1 and A2 only.
120 days from the date on which any of the Critical illnesses has been occurred. High S.A. Rebate : Nil Pregnant ladies: Not Allowed.

Example: Age- 35, Basic Plan: 814, Term - 25 years, S.A - `5,00,000, CIR S.A.: `5,00,000 Policy Loan: Not Available Non-Standard Age Proofs: Not allowed
Grace Period: As per Basic Plan Financial Underwriting:
Entry In case of Critical In case of Death Maturity
Revivals: Along with Basic Plan only. Age Group Max CIR-TRSA Allowed
Age 35 illness at Age 40 at Age 50 Age 60
Surrender Value: Payable under 18 -45: 8 times of Avg. income of last 3 yrs,
Limited Premium Policies. 46-65: 5 times of Avg. income of last 3 yrs,
and will be included in TRSA eligibility.
Death Benefit Claim Concessions: Not Applicable.
MHR is required as per SUC of Basic Plan.
= Death Benefit of Basic Plan Back Dating: Allowed as per Basic Plan.
(Whether CIR Benefit Availed or Not) Occupation Extra: Not Allowed to
Maturity Benefit Proposal Form: As per Basic Plan.
Proponents attracting occupation extra.
= Maturity Benefit of Basic Plan Service Tax: As per Basic Plan
Critical Illness Rider Benefit (Whether CIR Benefit Availed or Not) Keyman/Partnership/Empl-Employee:
Tax Benefits :
= CIR SA Opted + Rider Benefit Stops. Allowed only under Employer-Employee
On CIR Premiums : u/s 80D
= ` 5, 00,000 + Future Premiums of basic Plan only will continue. CIR claim : Tax Free NRIs & FNIOs : Not Allowed.

. PRERANA update of Safal Institute

4. EXCLUSIONS: 1. CONDITIONS AND RESTRICTIONS:
The Corporation shall not be liable to pay any of the benefit if the critical illness a) Critical Illness benefit will be payable only after the Corporation is satisfied
has occurred directly or indirectly as a result of any of the following: on the basis of available medical evidence and other requirements as
mentioned under Normal requirements of claims. However, in some
 Any of the listed critical illness conditions where death occurs within 30 illnesses covered under this rider, a specific deferment period applies to
days of the diagnosis establish permanence of the illness covered.
 Any sickness related condition manifesting itself within 90 days of the b) The Critical Illness Benefit Rider shall be payable only once during the term
commencement of risk or revival of risk cover, whichever is later.
of the policy while the policy is inforce. The Rider ceases to apply once the
 Intentionally self-inflicted injury or attempted suicide, irrespective of mental Critical illness Sum Assured becomes payable. The benefit shall also
condition. automatically cease to be available on Surrender of the base policy or if the
base policy is converted into a paid-up policy for a reduced Sum Assured.
 Alcohol or solvent abuse, or the taking of drugs except under the direction
of a registered medical practitioner*.
2. WAITING PERIOD:
 War, invasion, hostilities (whether war is declared or not), civil war,
rebellion, revolution or taking part in a riot or civil commotion. A waiting period of 90 days will apply from the date of commencement of risk or
 Taking part in any act of a criminal nature. date of revival of risk cover, whichever is later, to the first diagnosis of the
Critical Illness under consideration. This would mean that the benefit covered
 Any Pre-existing medical condition i.e. any condition, ailment or injury or under this rider is not applicable and the rider shall terminate if any of the
related condition (s) for which the policyholder had signs or symptoms, contingencies mentioned under List of Critical Illnesses Covered occurs:
and/or were diagnosed, and / or received medical advice / treatment within
48 months prior to the date of commencement/ revival of the policy. i. at any time on or after the date on which the risk under the Policy has
commenced but before the expiry of 90 days reckoned from that date or
 HIV or AIDS
ii. before the expiry of 90 days from the date of Revival.
 Failure to seek medical or follow medical advice (i.e. failure to undergo tests
or treatments that a prudent person would normally undergo as However, waiting period will not apply to conditions arising directly out of
recommended by a Medical Practitioner* accident.
 Radioactive contamination due to nuclear accident.
3. SURVIVAL PERIOD:
*A Medical practitioner is a person who holds a valid registration from the A survival period of 30 days is applicable from the date of diagnosis of Critical
medical council of any state or Medical Council of India or Council for Indian
Illness listed above. If death occurs within the survival period, Critical Illness
Medicine or for Homeopathy set up by the Government of India or a State
Benefit shall not be payable.
Government and is thereby entitled to practice medicine within its
jurisdiction; and is acting within the scope and jurisdiction of license but
excluding the Practitioner who is:
 Insured/Policyholder himself or an agent of the Insured.
 Insurance Agent, business partner or employer/employee of the Insured or
 A member of Insured's immediate family.

. PRERANA update of Safal Institute

5. TERMINATION OF CRITICAL ILLNESS BENEFIT RIDER:
The Critical Illness Benefit Rider will terminate on the earliest of:
 The date on which the claim is paid in respect of this rider.
 The date of expiry of the rider (as mentioned in the Schedule).
 The date on which the base policy to which the rider is attached
terminates or is converted into a paid up policy.
 On diagnosis of a Critical Illness within the waiting period
Any critical illness manifesting itself during the waiting period is not
admissible. The first admissible critical illness which is manifested, diagnosed
and lodged after the waiting period and during the currency of critical illness
cover, once admitted for, shall preclude any further critical illness and
therefore the cover will terminate.
Under an inforce policy this rider can be cancelled at any time during the
policy term and no surrender value shall be paid. Once the rider is cancelled it
can't be re-opted during the policy term.
The premium in respect of New Critical Illness Benefit Rider shall be
discontinued once this rider is terminated or cancelled.
6. REVIEW OF PREMIUMS:
The premium rates for Critical Illness Benefit Rider are guaranteed for a
period of first 5 years from the date of commencement of the policy. At the
end of every 5 policy years starting from the date of commencement of the
rider, the premium rates for future years will be subject to revision based on
the experience of the Corporation under this rider. The premium rates, if
revised, shall be guaranteed for a further period of 5 years. The installment
premium on each review will be based on age at entry i.e. age as on the
date of commencement of rider and original premium paying term.
Any such revision in premium rates under a policy after the approval from the
Authority shall be notified to each policy holder at least three months prior to
the date when such revision or modification conies into effect. The Life
Assured shall have the right to discontinue the Critical Illness Benefit Rider
and keep the Base Policy inforce in case the revised installment premium for
this rider is not acceptable. However, once discontinued the Critical Illness
Rider will not be allowed to be reinstated.
7. NORMAL REQUIREMENTS FOR CLAIM:
Within 120 days from the date on which any of the contingencies mentioned
under definitions of Critical Illnesses (as mentioned under Para 4 above) has been
occurred, full particulars hereof must be notified in writing to the office of the
Corporation where this Policy is serviced along with the address proof, if not
submitted earlier. Proof satisfactory to the Corporation of the contingency that
has been occurred shall be furnished in the manner required as below:
1. Claim Form duly signed by the insured along with NEFT mandate from the
Claimant for direct credit of the claim amount to the hank account;
2. Original Policy document;
3. Treating doctor certificate filled by the doctor treating the Life Assured for
the diagnosed ailment. The treating doctor should be a Medical Practitioner
registered in India/other country as approved by the Corporation, not being
the policyholder, Life Assured or the respective partner or spouse or
relatives.
4. Hospital certificate/Discharge Summary duly filled by the hospital where Life
Assured was admitted.
5. Confirmatory investigations including, but not limited to, clinical,
radiological, histological & laboratory evidence;
6. If the insured event requires the surgical procedure to he performed, the
procedure must be the usual treatment for the condition and be medically
necessary;
7. The Critical illness benefit shall be payable only on confirmation of the
diagnosis by a registered Medical Practitioner appointed/approved by the
Corporation;
8. In case of Critical Illness directly arising out of an Accident, claimant is
required to submit the following documents:
i. Certified copies of First Information Report (FIR) and the Final Police
Closure Report
ii. Any associated newspaper cutting
iii. Any other document or information as asked for by the Corporation
depending on the facts & circumstances of each case;
This would be in addition to the Claim requirements under the Base Policy.
. PRERANA update of Safal Institute
8. DEFINITIONS OF THE 15 CRITICAL ILLNESS COVERED:
(1) CANCER OF SPECIFIED SEVERITY:
A malignant tumor characterized by the uncontrolled growth and spread of
malignant cells with invasion and destruction of normal tissues. This diagnosis
must be supported by histological evidence of malignancy. The term cancer
includes leukemia, lymphoma and sarcoma.
The following are excluded —
i. All tumors which are histologically described as carcinoma in situ,
benign, pre-malignant, borderline malignant, low malignant potential,
neoplasm of unknown behavior, or non-invasive, including but not
limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, GIN -2
and CIN-3.
ii. Any non-melanoma skin carcinoma unless there is evidence of
metastases to lymph nodes or beyond;
iii. Malignant melanoma that has not caused invasion beyond the
epidermis;
iv. All tumors of the prostate unless histologically classified as having a
Gleason score greater than 6 or having progressed to at least clinical
TNM classification T2NOMO
v. All Thyroid cancers histologically classified as T1NOMO (TNM
Classification) or below;
vi. Chronic lymphocytic leukaemia less than RA1 stage 3
vii. Non-invasive papillary cancer of the bladder histologically described as
TaNOMO or of a lesser classification,
viii. All Gastro-Intestinal Stromal Tumors histologically classified as
T1NOMO (TNM Classification) or below and with mitotic count of less
than or equal to 5/50 HPFs;
ix. All tumors in the presence of HIV infection.
(2) OPEN CHEST CABG:
The actual undergoing of heart surgery to correct blockage or narrowing in one
or more coronary artery(s), by coronary artery bypass grafting done via a
sternotomy (cutting through the breast bone) or minimally invasive keyhole
coronary artery bypass procedures. The diagnosis must be supported by a
coronary angiography and the realization of surgery has to be confirmed by a
cardiologist.
The following are excluded:
I. Angioplasty and/or any other intra-arterial procedures
(3) MYOCARDIAL INFARCTION:
(First Heart Attack of specific severity)
I. The first occurrence of heart attack or myocardial infarction, which means
the death of a portion of the heart muscle as a result of inadequate blood
supply to the relevant area. The diagnosis for Myocardial Infarction should
be evidenced by all of the following criteria:
i. A history of typical clinical symptoms consistent with the diagnosis of
acute myocardial infarction (For e.g. typical chest pain)
ii. New characteristic electrocardiogram changes
iii. Elevation of infarction specific enzymes, Troponins or other specific
biochemical markers.
II. The following are excluded:
i. Other acute Coronary Syndromes
ii. Any type of angina pectoris
iii. A rise in cardiac biomarkers or Troponin T or I in absence of overt
ischemic heart disease OR following an intra-arterial cardiac procedure.
(4) KIDNEY FAILURE REQUIRING REGULAR DIALYSIS:
End stage renal disease presenting as chronic irreversible failure of both kidneys
to function, as a result of which either regular renal dialysis (haemodialysis or
peritoneal dialysis) is instituted or renal transplantation is carried out. Diagnosis
has to be confirmed by a specialist medical practitioner.
(5) MAJOR ORGAN /BONE MARROW TRANSPLANT (as recipient)
I. The actual undergoing of a transplant of:
i. One of the following human organs: heart, lung, liver, kidney, pancreas,
that resulted from irreversible end-stage failure of the relevant organ, or
ii. Human bone marrow using haematopoietic stem cells. The undergoing of
a transplant has to be confirmed by a specialist medical practitioner.
II. The following are excluded:
i. Other stem-cell transplants
ii. Where only islets of langerhans are transplanted
. PRERANA update of Safal Institute
(6) STROKE RESULTING IN PERMANENT SYMPTOMS:
I. Any cerebrovascular incident producing permanent neurological sequelae.
This includes infarction of brain tissue, thrombosis in an intracranial
vessel, haemorrhage and embolisation from an extracranial source.
Diagnosis has to be confirmed by a specialist medical practitioner and
evidenced by typical clinical symptoms as well as typical findings in CT
Scan or MRI of the brain. Evidence of permanent neurological deficit
lasting for at least 3 months has to be produced.
II. The following are excluded:
i. Transient ischemic attacks (TIA)
ii. Traumatic injury of the brain
iii. Vascular disease affecting only the eye or optic nerve or vestibular
functions.
(7) PERMANENT PARALYSIS OF LIMBS
Total and irreversible loss of use of two or more limbs as a result of injury or
disease of the brain or spinal cord. A specialist medical practitioner must be of
the opinion that the paralysis will be permanent with no hope of recovery and
must be present for more than 3 months.
(8) MULTIPLE SCLEROSIS WITH PERSISTING SYMPTOMS
I. The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and
evidenced by all of the following:
i. Investigations including typical MRI findings which unequivocally
confirm the diagnosis to be multiple sclerosis and
ii. There must be current clinical impairment of motor or sensory
function, which must have persisted for a continuous period of at
least 6 months.
II. Other causes of neurological damage such as SLE and HIV are excluded.
(9) AORTIC SURGERY:
The actual undergoing of major surgery to repair or correct an aneurysm,
narrowing, obstruction or dissection of the aorta through surgical opening of
the chest or abdomen. For the purpose of this definition, aorta shall mean the
thoracic and abdominal aorta but not its branches.
Surgery performed using only minimally invasive or intra-arterial techniques
are excluded.
(10) ALZHEIMER'S DISEASE/ DEMENTIA:
Deterioration or loss of intellectual capacity as confirmed by clinical
evaluation and imaging tests, arising from Alzheimer's Disease or irreversible
organic disorders, resulting in significant reduction in mental and social
functioning requiring the continuous supervision of the Life Assured for a
minimum period of 6 months from date of diagnosis. This diagnosis must be
supported by the clinical confirmation of an appropriate Registered Medical
practitioner who is also a Neurologist and supported by the Corporation's
appointed doctor.
The following are excluded:
i. Non-organic disease such as neurosis and psychiatric illnesses; and
ii. Alcohol-related brain damage.
(11) BLINDNESS:
I. Total, permanent and irreversible loss of all vision in both eyes as a result
of illness or accident.
II. The Blindness is evidenced by:
i. corrected visual acuity being 3/60 or less in both eyes or
ii. the field of vision being less than 10 degrees in both eyes.
III. The diagnosis of blindness must be confirmed and must not be
correctable by aids or surgical procedure.
(12) THIRD DEGREE BURNS:
There must be third-degree burns with scarring that cover at least 20% of
the body's surface area. The diagnosis must confirm the total area involved
using standardized, clinically accepted, body surface area charts covering
20% of the body surface area.
(13) OPEN HEART REPLACEMENT OR REPAIR OF HEART VALVES:
The actual undergoing of open-heart valve surgery is to replace or repair
one or more heart valves, as a consequence of defects in, abnormalities of,
or disease-affected cardiac valve(s). The diagnosis of the valve abnormality
must be supported by an echocardiography and the realization of surgery
has to be confirmed by a specialist medical practitioner. Catheter based
techniques including but not limited to, balloon valvotomy/valvuloptasty
are excluded.
. PRERANA update of Safal Institute
(14) BENIGN BRAIN TUMOR:
I. Benign brain tumor is defined as a life threatening, non-cancerous tumor
d in the brain, cranial nerves or meninges within the skull. The presence of
the underlying tumor must be confirmed by imaging studies such as CT
scan or MRI.
II. This brain tumor must result in at least one of the following and must be
confirmed by the relevant medical specialist.
i. Permanent Neurological deficit with persisting clinical symptoms for
a continuous period of at least 90 consecutive days or
ii. Undergone surgical resection or radiation therapy to treat the brain
tumor.
III. The following conditions are excluded:
Cysts. Granulomas, malformations in the arteries or veins of the brain,
hematomas, abscesses, pituitary tumors, tumors of skull bones and
tumors of the spinal cord.

(15) PRIMARY (IDIOPATHIC) PULMONARY HYPERTENSION

I. An unequivocal diagnosis of Primary (Idiopathic) Pulmonary
Hypertension by a Cardiologist or specialist in respiratory medicine with
evidence of right ventricular enlargement and the pulmonary artery
pressure above 30 mm of Hg on Cardiac Cauterization. There must be
permanent irreversible physical impairment to the degree of at least
Class IV of the New York Heart Association Classification of cardiac
impairment.

II. The NYHA Classification of Cardiac Impairment are as follows:

I. Class Ill: Marked limitation of physical activity. Comfortable at rest,
but less than ordinary activity causes symptoms.
II. Class IV: Unable to engage in any physical activity without
discomfort. Symptoms may be present even at rest.

III. Pulmonary hypertension associated with lung disease, chronic

hypoventilation, pulmonary thromboembolic disease, drugs and toxins,
diseases of the left side of the heart, congenital heart disease and any
secondary cause are specifically excluded.

. PRERANA update of Safal Institute